In this issue

The articles in this issue investigate phenomena related to marketing systems in a variety of geographic and industry contexts. The commentary in this issue by Roger Layton offers readers a unique perspective on how theory about marketing systems has developed and might likely develop in the future. The book reviews capture changing consumption behaviors which ultimately influence marketing systems and the outputs of marketing systems. In “Marketing and Regional Integration for Food Security in the Arab World”, Mark Speece and Mohsen Bagnied propose a new approach for regional food systems in the Middle East/ North Africa (MENA). This region faces serious food insecurity, with an increasing gap between food production and consumption. Using Resource-Advantage Theory from marketing, the authors show how the agriculture/agribusiness industry would be highly competitive with economic integration of the Nile Valley (Egypt and Sudan) with the Arab Gulf countries. Individually, these sub-regions have critical disadvantages, but as a bloc, complementary strengths could make the industry quite competitive. While many have discussed integration within MENA for decades (usually in political terms), economic integration could become very beneficial to food security in the region. The second article in the issue is “A Dynamic Stakeholders’ Framework in a Marketing Systems Setting” by Christine Domegan, Patricia McHugh, Tina Flaherty and Sinead Duane. Here, the authors take the view that a marketing-systems approach to stakeholders has never been more important in an increasingly interconnected world. The article presents a systemic stakeholders framework that incorporates several defining features and core propositions based on Layton’s MAS mechanisms and Coleman’s Boat. The contribution of a dynamic stakeholders’ marketing system framework is not so much in identifying or defining the appropriate marketing mechanisms at work but in understanding the continuous feedback nature of the macro-micro-macro everyday dynamics which involve stakeholders. In the third article, Daniel Shen considers whether the effects of the 1960’s are still with those who lived during this era. Researchers have found that aging members of the Baby Boom Generation are more vulnerable to mental and physical health-problems. Part of this may be due to the adoption of lifestyles in the Age of Aquarius somewhere around the time of Woodstock which now appear to be more resistant to change. For example, Shen’s analysis suggests that withdrawal from institutional religion four or five decades ago is associated with alcohol excess and cigarette smoking among aging Boomers in 2016. Shen modified Rahtz and Szykman’s (2008) model of preventive healthcare to include withdrawal from institutional religion. In this way, Shen offers readers better understanding for such a withdrawal’s possible impact on lifestyle change, health, and quality of life. The fourth article “Macro-demarketing: The Key to Unlocking Unsustainable Production and Consumption Systems?” by Vicki Little, Christina Lee and Sumesh Nair examines the effects of a tax policy on reducing environmental degradation. The authors conducted an ethnographic case-study of a failed plastic-bag-tax in Malaysia. Despite widespread awareness and espoused support, the tax failed to meet policy goals. Addressing the limitations of the voluntary individual choice perspective, the study contributes insight into resistance to interventions at multiple levels and among multiple stakeholders. The fifth article “The Role of Style versus Fashion Orientation on Sustainable Apparel Consumption” by Shipra Gupta, Wencke Gwozdz and Jim Gentry offers readers insight about whether promoting a style orientation among consumers (rather than a fashion orientation) will lead to more sustainable apparel consumption. Data collected from 6,386 consumers across five countries that are considered to be leaders in sustainable development (Sweden, Netherlands, Germany, the U.K., and the U.S.) suggest that promoting style can be a potential solution to attain slow fashion and, thus, improve sustainable apparel consumption. The article closes with discussion about the need for the collective effort of different actors (especially, government), in creating a more sustainable fashion-system. The commentary in this issue is one of much value for all macromarketers. Roger Layton offers his thoughts about the development of research focused on marketing systems and its possible development in the future in “Marketing Systems – Looking Back, Looking On and Looking Forward”. This commentary was written to serve as the introduction to the SAGE Publications virtual book Marketing Systems – The Evolution of a Concept over Time which focuses on the past, present and future of thinking related to marketing systems. The entire virtual book can be accessed by all at https://journals.sage

Alsharif provides insight into the value of artificial intelligent (AI) tools combined with diverse imaging modalities in breast lesion detection and diagnosis. The shift from the conventional computer-aided detection (CAD) system to the advanced AI tools such as DL-CAD has the potential to reduce false-positive findings, increase diagnostic accuracy, improve radiologist performance, and assist with decision-making. Breast imaging faces challenges with the current increase in medical imaging requests and lesions that breast screening programs can miss. Solutions to improve these challenges are being sought with the recent advancement and adoption of artificial intelligent (AI)-based applications to enhance work ow efficiency as well as patient-healthcare outcomes. Using small datasets from the same source may raise concerns regarding the depth, quality, and representativeness of the images that are used to teach the AI-based applications and increase the possibility of bias and overfitting.

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Çevikkalp et al investigate 40 patients from Private Medicabil Hospital in Turkey the effcacy of bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane (BLTAP) block in laparoscopic cholecystectomy (LC). The 1-hour visual analog scale (VAS) score at rest was lower in the BLTAP block group than in the standard analgesia (SA) and unilateral laparoscopic-assisted transversus abdominis plane (ULTAP) block groups. The change in VAS score was higher in the SA group than in the BLTAP block group. Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block technique is more effective than standard analgesia, local anesthetic infiltration, and ULTAP block in preventing early postoperative pain after LC.

see page 145
The utilization of artificial intelligence applications to improve breast cancer detection and prognosis

Review ARticle
A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery Hong et al compare 60 patients undergoing video-assisted thoracic surgery (VATS) received patient-controlled thoracic epidural analgesia (TEA) with a basal rate of 3 ml/hour (h), a bolus of 3 ml (Group E), or efficacies of erector spinae plane (ESP) block with programmed intermittent bolus infusions of 15 mL/3 h and a bolus of 5 ml (Group ES) for 2 postoperative days. Patients with continuous ESP block had a higher NRS score than those with TEA but no statistical difference at a specific time. Erector spinae plane block may be inferior to TEA for analgesia following VATS, but it could have tolerable analgesia and a better side effect profile than TEA. Therefore, it could be an alternative to TEA as a component of multimodal analgesia.

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ORiginAl ARticles

Bilateral 4-quadrant laparoscopic-assisted transversus abdominis plane block reduces early postoperative pain after laparoscopic cholecystectomy. A prospective, single-blind, randomized study
Alharbi et al report a 53-year-old male who was referred to the Pulmonary Medicine clinic for a dry cough for 6 weeks, associated with minimal sputum production which was yellowish in color without blood. Chronic cough is one of the most common symptoms encountered in respiratory clinics. It has a variety of differential diagnoses, and without a clear algorithmic approach, the final diagnosis can be overlooked. This case demonstrate the challenges of diagnosing pulmonary tumor thrombotic microangiopathy despite advancements in diagnostic imaging and the associated high fatality, despite advances in oncological treatments, mostly due to the aggressive behavior of the underlying malignancy and the relatively late diagnosis.

see page 218
Bilateral faint ground glass opacities with tree-in-bud appearance and mild bronchial wall thickening, more pronounced at the right lower lobe.

cARe RepORt
Doyle's bulge after the injection of local anesthetic.